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Women’s Right to Choose

07.30.10: ACOG lightens up.

Kudos to the American Congress of Obstetricians and Gynecologists (ACOG) for taking a step in the right direction. Last week, they announced less restrictive guidelines for VBACs, twin births and other candidates for vaginal delivery. ACOG realized their previous guidelines for when VBACs could occur essentially eliminated most of them. They were so restrictive they’d radically increased the c-section rate, somewhat increased the maternal mortality rate and alienated an entire generation of mothers. It’s about freaking time ACOG dialed their control issues.

Many of my very favorite people and good friends are obstetricians. Not only are they good doctors, they’re good people with big hearts, brilliant minds and a true desire to take really good care of people. I know many OBs who were so frustrated with ACOG’s vaginal delivery restrictions and rules about what kind of patient care they were allowed to provide, that they gave up. They couldn’t, in good conscience, follow ACOGs rules. They also couldn’t break them without losing their malpractice insurance or the support of the hospitals they delivered at. So, not only did ACOG alienate mothers, they alienated doctors too. Doctors who up and quit practicing obstetrics.

Now, that ACOG has decided the pendulum can start swinging back to a reasonable climate for obstetric care, it’s time for parents to grab hold and swing hard. Push your doctors and midwives to accept your right to choose how you want to deliver. It’s not going to be like flipping a switch. Change comes gradually unless you push it and make it happen faster. Obstetrics is a market-driven industry just like any business. If patients demand safe, vaginal deliveries and are willing to take their business elsewhere, doctors will have to offer that service. If we support providers who support vaginal birth, their market share will grow. See? It is just good business. OK, it’s also good patient care.

ACOG president Dr. Richard Waldman, MD said, “Given the onerous medical liability climate for ob-gyns, interpretation of The College’s earlier guidelines led many hospitals to refuse allowing VBACs altogether,” said Dr. Waldman. “Our primary goal is to promote the safest environment for labor and delivery, not to restrict women’s access to VBAC.”

Alrighty then, what does this mean for you? It means that if you’ve already had one c-section, you don’t have to automatically have another one. Your hospital can’t stand in the way of you trying for a vaginal birth if you want one. They can no longer say, “Sorry, lady, once a c-section, always a c-section because ACOG says so.” Now, it’s official: You Get To Choose. That choice is called TOLAC – trial of labor after cesarean. ACOG says, “Approximately 60-80% of appropriate candidates who attempt VBAC will be successful.”

ACOG recommends doctors seriously counsel patients about the risks versus benefits of VBAC. When they have this chat with their patients, now they’re supposed to focus on the low risk of uterine rupture (0.5 to 0.9%) and the much higher risks associated with c-section. My question is: Weren’t doctors having this conversation before ACOG lightened up? The numbers haven’t changed. VBAC was just as safe before ACOG released new guidelines last week. The only difference is ACOG changed its tone of voice.

Does anyone else think that ACOG sounds like an overbearing parent bullying adult children? For heaven’s sake, doctors and mothers are adults. Don’t treat them like children who don’t know what’s good for them.

ACOG does have a point about the onerous medical liability climate for ob-gyns. Every birth comes with risks. If we’re ever going to create serious climate change, women have to take responsibility too and quit blaming doctors and midwives for everything that goes wrong. If she makes the choice to VBAC, she accepts certain risks. However, small those risks are, the right to choose comes with personal responsibility.

Seriously, not many doctors/midwives are negligent. Most don’t mal-practice. Sometimes, doctors, midwives, nurses and patients all do their best to produce a perfect birth and still, things can go wrong. The reason why ACOG makes restrictions and guidelines is, in part, because they’re trying to make things safe across the board but also, because doctors and hospitals get sued if a baby doesn’t come out perfect. Even if they do their best and provide excellent patient care; stuff happens. Birth is a risk.

The next step in reducing the c-section rate is to avoid having that first one. We’ve talked about this before – take responsibility for your health. Don’t gain too much weight. Don’t eat the wrong foods. Exercise. Don’t smoke, drink or do drugs. Get prenatal care. Then, limit the choices you make for interventions like unnecessary inductions. If your doctor starts talking about c-sections during prenatal care, find out exactly why. Then get a second opinion, just like you would with any major surgery.